A Minnesota district court ruled this week that the state’s Medical Assistance program must cover necessary services related to gender transition for transgender people.
The American Civil Liberties Union (ACLU), along with the ACLU of Minnesota, filed a lawsuit in December 2015 on behalf of Evan Thomas, a transgender man, and OutFront Minnesota, the state’s largest LGBTQ rights organization.
Thomas, who has been diagnosed with gender dysphoria, was denied coverage for transition-related surgery. Minnesota has excluded surgical treatments for gender dysphoria from its Medical Assistance program since 2005, even though private insurance plans and the federal Medicare program cover equivalent treatments. That exclusion, District Court Judge William Leary ruled, discriminates against transgender people and violates their fundamental right to privacy.
Thomas is a 64-year-old who experienced severe depression related to gender dysphoria, according to court documents. At the height of his depression, Thomas experienced suicidal thoughts. Thomas eventually sought medical care for his depression, and began receiving hormone therapy.
While the hormone therapy alleviated some of Thomas’ depression, according to court documents, he continues to experience anxiety and depression because his anatomy, particularly his breasts, do not match his gender identity and presentation. Thomas uses chest compression devices and clothing to hide his breasts, a practice known as binding that can be extremely uncomfortable. Long-term binding can be unhealthy and can lead to other conditions like acute bronchitis, according to medical experts.
Gender-affirming surgery alleviates the need for binding. But until Leary’s ruling, that procedure was unavailable for transgender patients on the state’s Medical Assistance program.
“I’m so happy we’ve won,” Thomas said in a statement. “The judge’s ruling is a forceful statement that transgender people deserve equal treatment under the law. Right now, when we’re suddenly facing a path that’s so much rougher than it looked a few days ago, this victory looks even more important.”
Denying transgender patients access to necessary medical care is a national issue, with advocates filing lawsuits across the country on behalf on people who have faced such discrimination.
Section 1557 of the Affordable Care Act (ACA) attempts to remedy this by forbidding health-care programs that receive federal funding from discriminating on the basis of gender. A number of states with conservative governors have challenged this section of the ACA, arguing that it improperly infringes on religious rights. That litigation is ongoing.